The Olympic ideal

LAST year’s London Olympic Games placed sports stars on the front pages of newspapers, thanks in no small part to Team GB’s considerable medal haul. But a number of athletes attracted media attention for less positive reasons, with many falling foul of strict anti-doping rules. Is it, therefore, fair to hold their misdeeds as being representative of society and all its imperfections?

By extending the comparison to the dental profession, we might ask ourselves whether dentists are more ethical than society as a whole or merely representative of society and its imperfections? Does the carrot of a gold medal or increased financial income influence the behaviours of each group?

The Olympic ideal was espoused by Baron de Coubertin in the late 19th century after he visited “The Much Wenlock Olympian Games” in Shropshire in 1890. He said: “The most important thing in the Olympic Games is not winning but taking part.” For much of the 20th century Olympic athletes were amateur and refused to be tainted by money. But while medals remain the only prizes for winners, many athletes have third party sponsorship contracts tied to their success.

So how do dentists compare? Dentists are “professionals”. The public looks up to professionals. They aspire to be a dentist. In return dentists are expected to behave differently, “to put patients’ interests first” as the General Dental Council (GDC) puts it.

However, the word “professional” in sport has become tainted. Whilst it can mean hard working, well prepared and totally dedicated it can also mean taking gamesmanship to the wire as in “the professional foul” or in not admitting an offence the referee has not detected.

It is often said there is no right or wrong in an ethical viewpoint. We all hold different views based upon our genes, upbringing, culture, beliefs and experience. However, we are all bound by the laws of the land which in theory are based on ethical views. In dentistry, however, your ethical position is decided not by yourself but by a third party – the GDC. If the GDC considers you have behaved unethically it can impose sanctions including, in the most extreme cases, removing your right to work.

So let us examine some recent events in sport. At the 2012 Olympics eight badminton players who had broken no regulation were sent home for not trying. The cricketer Stuart Broad received much criticism from some Australians for not “walking” when he knew he had touched the ball with his bat and was caught out.

But sometimes in sport the issues are less clear-cut. In the sailing events at last year’s Olympics Ben Ainslie was leading a race. He did not attempt to race for the winning line but tacked back and forth attempting to disrupt the flow of wind from his sails into the sails of his second placed opponent (Jonas Hogh-Christensen) who was close behind. If the Dane had finished second he would have won gold not Ainslie. In the end, Hogh-Christensen finished fifth and Ben Ainslie won a fourth gold medal and is now Sir Ben Ainslie!

“Bloodgate” was a 2009 scandal involving the rugby union side Harlequins. During a match, one of their players used a fake blood capsule to feign injury allowing a tactical substitution. The subterfuge was amateurish and when off the pitch the player (Tom Williams) asked the club doctor to cut his lip. She eventually complied but the ruse was found out and the case had far reaching consequences.

The coach was banned for two years and the player was banned for four months. The club doctor, however, was suspended by the General Medical Council (GMC) pending an investigation into her conduct. She was eventually given a warning by the GMC and returned to practice 18 months after the incident.

It can be seen that actions outside one’s normal place of work can have far-reaching consequences with our regulatory bodies. It could be argued that the doctor had valid consent and the patient’s autonomy allowed this course of action. However, the inherently unethical action was considered to be a potential fitness to practise issue by the GMC.

Dentists’ actions are governed by the GDC whose recently published Standards for the dental team states that you should “make sure your personal behaviour maintains patients’ confidence in you and the dental profession”. It adds that you must “be honest and act with integrity”, making clear that the word ‘must’ is used “where the duty is compulsory”.

Thus regulatory guidelines are unequivocal. Not only must you stick to the letter of the law in all your actions but you must also conduct yourself with honesty and integrity. The GDC also emphasises this applies not only within your clinical practice but also outside in your business, educational and personal lives.

The GDC’s new guidelines are a must (and I do mean a “must”) for all dental professionals to read. Lack of knowledge of this guidance is no defence. They are clear and easy to read. Finally if you break the letter or the spirit of this guidance this could result in the stress of a fitness to practise hearing with the possible penalty of being unable to earn your living for the next five years.

Dick Birkin is Secretary of the Dental Law and Ethics Forum and acts as an expert witness to the GDC on regulations and record keeping